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Ren J, Zhang X, Zeng JH, Gao YX. Influencing factors of self-management ability among dry eye patients in west China. Int J Ophthalmol 2024; 17:1621-1627. [PMID: 39296555 PMCID: PMC11367422 DOI: 10.18240/ijo.2024.09.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/30/2024] [Indexed: 09/21/2024] Open
Abstract
AIM To investigate the current situation and influencing factors of self-management ability in dry eye patients in west China. METHODS A total of 265 patients clinically diagnosed with dry eye received a convenience survey questionnaire at West China Hospital of Sichuan University. All participants completed the rating scale of health self-management skill for adults (AHSMSRS), Huaxi Emotional-Distress Index (HEI), e-health literacy scale (e-HEALS) and Brief Illness Perception Questionnaire (Brief-IPQ). A generalized linear model was employed to establish a multivariate linear model with demographic data, psychological state, e-HEALS, and illness perception as independent variables and health self-management skill score as the dependent variable. RESULTS The mean score for health self-management skill was 165.58±15.79. Multivariate analysis revealed that advanced age, better illness perception and improved psychological state were associated with better health self-management ability among dry eye patients. Furthermore, the health self-management ability of patients with a disease duration less than 1y was found to be higher compared to those with a disease duration exceeding 1y. CONCLUSION The health self-management ability of dry eye patients in west China is relatively high. Age, duration of disease, illness perception and psychological state are the influencing factors on the health self-management ability of dry eye patients.
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Affiliation(s)
- Jie Ren
- Department of Ophthalmology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Hong Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yun-Xia Gao
- Department of Ophthalmology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
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Huang M, Yan X, Gao Y, Song W, Cheng Y, Xie L, Li Y, Zhou X, Yang S. The effect of type 2 diabetes mellitus on lid wiper epitheliopathy and ocular surface parameters. Heliyon 2024; 10:e36912. [PMID: 39281498 PMCID: PMC11402120 DOI: 10.1016/j.heliyon.2024.e36912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 08/09/2024] [Accepted: 08/23/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction This cross-sectional study was conducted to investigate the impact of type 2 diabetes mellitus(DM) and its duration on indicators such as lid wiper epitheliopathy(LWE), and to assess the significance of LWE for early diagnosis of dry eye disease(DED) in DM patients. Methods A total of 137 subjects with ocular surface disease index(OSDI) score ≥13 were divided into the non-DM group, the short-term DM group (duration <5 years), and the mid-to-long-term DM group(duration ≥5 years). Evaluations were conducted for LWE, OSDI, lipid layer thickness (LLT), partial blinking rate (PBR), fluorescein tear breakup time (FTBUT), corneal fluorescein staining score (CFS), eyelid margin score, and meibomian gland dropout (MGd). Results The upper-LWE score and total LWE score in the mid-to-long-term group were higher than those in the non-DM group (p = 0.008 and p = 0.031, respectively). The lower-LWE scores were more severe than upper-LWE scores in the non-DM and short-term groups (p = 0.001 and p = 0.045, respectively).The confirmed diagnosis rate of DEWSII dry eye with LWE as the primary diagnostic indicator was significantly higher than that which utilize FTBUT<5s as the primary diagnostic indicator(p < 0.05). Compared to the non-DM group, the LLT was thinner and the MGd was more severe in the mid-to long-term group. The upper-LWE score was moderately positively correlated with the MGd, and the lower LWE score was moderately negatively correlated with LLT. Conclusion LWE, LLT, and MGd worsen with the progression of diabetes. Additionally, changes in LWE may precede the FTBUT, indicating that LWE could be considered as an important indicator for early diagnosis of DED in diabetic patients.
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Affiliation(s)
- Meiting Huang
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Xiaoming Yan
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Yuan Gao
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Wenjing Song
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Yu Cheng
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Luoying Xie
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Yingsi Li
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Xuecong Zhou
- Peking University First Hospital, Xicheng District, Beijing, China
| | - Songlin Yang
- Peking University First Hospital, Xicheng District, Beijing, China
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Duan S, Tian B, Huang G, Huang S, Zhou S. A Rabbit Dry Eye Model Induced by Subcutaneous Scopolamine. Curr Eye Res 2024; 49:905-913. [PMID: 38717185 DOI: 10.1080/02713683.2024.2349642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 08/10/2024]
Abstract
PURPOSE To establish and characterize a dry eye model in New Zealand rabbits by subcutaneous injections of scopolamine hydrobromide (SCOP). METHODS Twenty New Zealand male rabbits were injected subcutaneously SCOP for 14 consecutive days; subcutaneous saline was used as a negative control. The correlated clinical parameters of ocular surface dryness were detected in vivo using tear secretion and corneal fluorescein staining. The expression of IL-1β and TNF-α on the ocular surface and in lacrimal glands were analyzed by real-time PCR and western blot on the 14th day. The expression of Mucin-5 subtype AC (MUC5AC) was detected by Immunofluorescence staining in conjunctival tissue. RESULTS The SCOP-treated rabbits exhibited significantly decreased aqueous tear secretion and increased corneal fluorescein staining scores over time. Both the mRNA expression levels and the protein expression levels of IL-1β and TNF-α were significantly increased after SCOP treatment compared with those after saline treatment. The loss of conjunctival MUC5AC was found in the SCOP-injected rabbits. Some infiltrated inflammatory cells and atrophic acinar cells were observed in the lacrimal gland after SCOP treatment. The disordered structures of the ocular surface and lacrimal glands were also observed. CONCLUSIONS This study showed that repeated subcutaneous SCOP injections successfully elicited some of the typical dry eye symptoms commonly seen in humans.
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Affiliation(s)
- Sujuan Duan
- The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bishan Tian
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
| | - Guofu Huang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
| | - Shitong Huang
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
| | - Shiyou Zhou
- The State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, China
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Troisi M, Del Prete S, Troisi S, Marasco D, Rinaldi M, Costagliola C. Scanning Electron Microscopy (SEM) Evaluation of the Ultrastructural Effects on Conjunctival Epithelial Cells of a New Multiple-Action Artificial Tear Containing Cross-Linked Hyaluronic Acid, Cationic Liposomes and Trehalose. Biomedicines 2024; 12:1945. [PMID: 39335459 PMCID: PMC11429469 DOI: 10.3390/biomedicines12091945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/12/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
The authors performed an ex vivo and in vivo evaluation of the ultrastructural effects on the conjunctival epithelial cells of a new multiple-action tear substitute containing cross-linked hyaluronic acid, lipids and trehalose (Trimix®), using scanning electron microscopy (SEM) with conjunctival impression cytology. The ex vivo study highlights the persistence and distribution of the product at 5 and 60 min on a monolayer of conjunctival epithelial cells and an increase in microvilli density at the 60 min evaluation. In vivo examination was conducted on three subjects with different grades of ocular surface inflammation, treated with one drop of the product twice daily for thirty days. At the baseline (T0) and twelve hours after the last administration of the tear drop (T30), impression cytology of the upper bulbar conjunctiva for SEM evaluation of conjunctival epithelial cells was carried out. Slit lamp examination (SLE), corneal and conjunctival Fluotest, tear film break-up time (TBUT), and ocular surface disease index (OSDI) questionnaires were also performed to correlate the ultrastructural results with the clinical findings. After 30 days of treatment, a significant improvement in all clinical and symptomatic parameters and in the condition of the ocular surface was detected, with microvillar regeneration and strengthening in all the patients, and a complete restoration in 2/3 of them. The persistence and distribution of the product on the epithelial cells was also noted 12 h after the last administration. The results, therefore, suggest a marked epitheliotropic effect along with a high residence time of the tear substitute.
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Affiliation(s)
- Mario Troisi
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy;
| | | | - Salvatore Troisi
- Ophthalmologic Unit, Salerno Hospital University, 84100 Salerno, Italy;
| | - Daniela Marasco
- Service Biotech s.r.l., 80121 Naples, Italy; (S.D.P.); (D.M.)
| | - Michele Rinaldi
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy;
| | - Ciro Costagliola
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, 80131 Naples, Italy;
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Krawczyk A, Stadler SM, Strzalka-Mrozik B. Nanomedicines for Dry Eye Syndrome: Targeting Oxidative Stress with Modern Nanomaterial Strategies. Molecules 2024; 29:3732. [PMID: 39202812 PMCID: PMC11357096 DOI: 10.3390/molecules29163732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
Dry eye syndrome (DES) is a dynamic, chronic disease of the ocular surface and ocular appendages caused by inflammation. The most common symptoms include redness, itching, and blurred vision, resulting from dysfunction of the meibomian glands and impaired tear-film production. Factors contributing to the development of DES include environmental elements, such as UV radiation, and internal elements, such as hormonal imbalances. These factors increase oxidative stress, which exacerbates inflammation on the surface of the eye and accelerates the development of DES. In recent years, the incidence of DES has risen, leading to a greater need to develop effective treatments. Current treatments for dry eye are limited and primarily focus on alleviating individual symptoms, such as reducing inflammation of the ocular surface. However, it is crucial to understand the pathomechanism of the disease and tailor treatment to address the underlying causes to achieve the best possible therapeutic outcomes. Therefore, in this review, we analyzed the impact of oxidative stress on the development of DES to gain a better understanding of its pathomechanism and examined recently developed nanosystems that allow drugs to be delivered directly to the disease site.
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Affiliation(s)
| | | | - Barbara Strzalka-Mrozik
- Department of Molecular Biology, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055 Katowice, Poland; (A.K.); (S.M.S.)
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Medic N, Boldin I, Berisha B, Matijak-Kronschachner B, Aminfar H, Schwantzer G, Müller-Lierheim WGK, van Setten GB, Horwath-Winter J. Application frequency - key indicator for the efficiency of severe dry eye disease treatment - evidence for the importance of molecular weight of hyaluronan in lubricating agents. Acta Ophthalmol 2024; 102:e663-e671. [PMID: 38131131 DOI: 10.1111/aos.16609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/09/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE Lubricant eye drops are the main therapeutic resource for dry eye disease (DED), with each drop representing the equivalent of ocular surface disease treatment. Thus, any reduction in the frequency of eye drop application reflects a degree of therapeutic success. Considering also the socioeconomic burden of DED, we investigated eye drop application frequency (DF) as a parameter to potentially track the success of therapy in severe DED. Hyaluronan (HA)-containing eye drops have become the first choice for tear substitution in many countries, and recent data indicate that the average molecular weight (Mw) of HA determines the therapeutic efficacy of such eye drops. This post-hoc subgroup analysis of a previously published multicentre prospective randomized open-label study, HYLAN M, is set out to compare the effects of very high Mw HA (hylan A) eye drops to comparator eye drops, containing lower Mw HA (control). METHODS Patients with severe DED (n = 47), recruited as part of the larger HYLAN M prospective, multicentre, open-label study, were randomized into two groups: hylan A and control group. In the hylan A group, 24 patients replaced their HA-containing eye drops with eye drops containing 0.15% hylan A, whereas the 23 control patients continued to use comparator HA eye drops. The DF was recorded daily by all participants over 8 weeks, and other subjective and objective parameters of DED were assessed at the time of inclusion (baseline), as well as at week 4 and 8. RESULTS There was a significant decrease in DF in the hylan A users between the baseline and week 4 (p = 0.004), remaining stable until week 8. Indeed, in contrast to the baseline, the hylan A group had a significantly lower DF than the control group at weeks 4 (p = 0.018) and 8 (p = 0.008). Likewise, the ocular surface disease index (OSDI) improved significantly between the time of inclusion and week 4 (p < 0.001) in hylan A users, remaining stable until week 8. The OSDI was similar in both groups at the baseline but it was significantly lower in the hylan A group than in the control group at week 4 (p = 0.002), remaining lower at week 8. Such a decrease in the DF and OSDI was not witnessed in the control group at any time point. The objective parameters assessed did not differ significantly within or between the two groups. CONCLUSION When treating severe DED, the DF can be significantly reduced by using very high Mw HA (3 MDa) lubricant eye drops, which better alleviate DED symptoms and decrease the OSDI scores. These drops not only provide an attractive and comfortable alternative for patients with severe DED but also offer the possibility of reducing the disease's socioeconomic burden, both for affected individuals and society as a whole.
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Affiliation(s)
- Nika Medic
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Ingrid Boldin
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Bujar Berisha
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | | | - Haleh Aminfar
- Department of Ophthalmology, Medical University of Graz, Graz, Austria
| | - Gerold Schwantzer
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | | | - Gysbert-Botho van Setten
- Department of Clinical Neuroscience, St. Eriks Eye Hospital, Karolinska Institutet, Stockholm, Sweden
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Liao X, Aljufairi FMAA, Sebastian JU, Jia R, Wong HYM, Lai KKH, Chen W, Hu Z, Wei Y, Chu WCW, Tham CCY, Pang CP, Chong KKL. Investigation of lacrimal gland and extraocular muscle in thyroid eye disease patients with severe subjective dry eye disease: a multiparametric magnetic resonance imaging study. Graefes Arch Clin Exp Ophthalmol 2024; 262:2651-2659. [PMID: 38456927 PMCID: PMC11271383 DOI: 10.1007/s00417-024-06424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To analyze the radiological features of the lacrimal gland (LG) and extraocular muscle (EOM) in thyroid eye disease (TED) patients with severe subjective dry eye disease (DED) using magnetic resonance imaging (MRI) measurements. METHODS In this cross-sectional study, mechanical ocular exposure, dry eye assessment and MRI data were collected. Patients were classified into non-severe subjective DED group with ocular surface disease index (OSDI) < 33 and severe subjective DED group with OSDI ≥ 33. Linear regression model was applied for comparing the OSDI < 33 and OSDI ≥ 33 group in TED patients. The predictive performance of MRI parameters and models was assessed by receiver operating characteristic curve (ROC) analysis. RESULTS Consecutive 88 TED patients (176 eyes) were included in this study. In the OSDI < 33 group, 52 TED patients (104 eyes) with a mean clinical activity score (CAS) of 0.63 ± 0.75. In the OSDI ≥ 33 group, there are 36 TED patients (72 eyes), with a mean CAS of 1.50 ± 1.54. The age and sex of the patients were matched between the two groups. The OSDI ≥ 33 group had shorter tear break-up time, larger levator palpebrae superioris / superior rectus (LPS/SR), inferior rectus and lateral rectus, smaller LG, more inflammatory LPS/SR and inferior rectus than OSDI < 33 DED group (P < 0.05). In the linear regression analysis, compare to the OSDI < 33 DED group, the OSDI ≥ 33 group had larger medial rectus cross-sectional area (β = 0.06, 95%CI: (0.02, 0.10), P = 0.008), larger inferior rectus cross-sectional area (β = 0.06, 95%CI: (0.00, 0.12), P = 0.048), smaller LG cross-sectional area (β = -0.14, 95%CI: (-0.25, -0.04), P = 0.008). In the ROC analysis, the area under curve of medial rectus, inferior rectus, LG, and combined model are 0.625, 0.640, 0.661 and 0.716, respectively. CONCLUSION Multiparametric MRI parameters of the LG and EOM in TED patients with severe subjective DED were significantly altered. Novel models combining the cross-sectional area of LG, medial rectus and inferior rectus showed good predictive performance in TED patients with severe subjective DED.
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Affiliation(s)
- Xulin Liao
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Fatema Mohamed Ali Abdulla Aljufairi
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
- Department of Ophthalmology, Salmaniya Medical Complex, Government Hospitals, Manama, 435, Bahrain
| | - Jake Uy Sebastian
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Ruofan Jia
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hanson Yiu Man Wong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Kenneth Ka Hei Lai
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
- Department of Ophthalmology, The Prince of Wales Hospital, Hong Kong SAR, China
| | - Wanxue Chen
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Zhichao Hu
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Yingying Wei
- Department of Statistics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement Chee Yung Tham
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China
| | - Kelvin Kam Lung Chong
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Hong Kong SAR, China.
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Sun CC, Hsu SL, Liang CM, Tsai YY, Lin PY. Bridging the gap in managing dry eye disease: a consensus report by the Taiwan society of cataract and refractive surgeons. BMC Ophthalmol 2024; 24:314. [PMID: 39075430 PMCID: PMC11285138 DOI: 10.1186/s12886-024-03565-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/08/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND An impaired ocular surface presents substantial challenges in terms of planning for cataract surgery. As a multifactorial ocular disorder, dry eye disease (DED) is common in the general population and prevalent in patients scheduled for lens replacement surgery. Cataract surgery can exacerbate DED and worsen several ocular parameters. Timely diagnosis and appropriate treatment of DED are vital to ensuring positive ophthalmic surgical outcomes. This consensus report of the Taiwan Society of Cataract and Refractive Surgeons (TSCRS) regarding the management of DED before, during, and after cataract surgery highlights the gaps between clinical guidelines and several aspects of DED, including diagnostic testing, diagnostic criteria, and clinical practice treatment. METHODS An expert panel of five specialists in the field of ophthalmology was recruited to develop consensus statements regarding the management of DED in both the general population and in patients undergoing cataract surgery in Taiwan. Two separate meetings of the five specialists, who were endorsed by the TSCRS, were convened for this purpose. A survey questionnaire consisting of binary or multiple-choice questions was developed through a consensus-driven formulation process. A percentage value was calculated for each statement, and a minimum of 60% agreement (equivalent to three out of five members) was required to achieve consensus. The second discussion meeting involved the presentation of the finalized consensus statements and concluded the consensus development process. Lastly, the finalized consensus statements were approved by all the experts, and the formulated recommendations for DED in the general population and prospective cataract surgery patients were accordingly presented. RESULTS The optimal algorithm for managing DED in the general population and in patients scheduled for cataract surgery was developed to address the unmet needs of this cohort in Taiwan. CONCLUSION This report provides recommendations for managing dry eye disease. It is essential to screen and confirm DED through endorsed questionnaires and tests and then diagnose it. Treatment and management of DED should follow a stepwise approach. Screening and diagnosing DED is also recommended before cataract surgery. After cataract surgery, relatively aggressive treatment strategies are recommended to manage DED effectively.
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Affiliation(s)
- Chi-Chin Sun
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shiuh-Liang Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Yi-Yu Tsai
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan.
| | - Pei-Yu Lin
- Department of Ophthalmology, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Ekicier Acar S, Özdemir Yildiz Z. Dry eye disease as an occupational risk factor in operating room nurses. Clin Exp Optom 2024:1-5. [PMID: 39074815 DOI: 10.1080/08164622.2024.2380077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024] Open
Abstract
CLINICAL RELEVANCE Knowing occupational risks in a multifactorial disease such as dry eye disease is important for disease diagnosis and treatment. BACKGROUND Dry eye disease (DED) is a multifactorial disease of the ocular surface characterised by tear film instability, adversely affecting visual function and quality of life. The operating room environment has many risk factors for DED such as air conditioning, constant humidity, constant room temperature, intense lighting, surgical smoke, anaesthetic gases and irritating chemicals, and prolonged mask use. This study investigates the ocular surface findings and blink patterns of operating room nurses at risk of DED. METHODS A total of 68 nurses (operating room, n = 34; outpatient clinic, n = 34) were included in this study. The diagnosis of DED was assessed using a questionnaire, best-corrected visual acuity, tear break-up time, corneal fluorescein staining, meibomian gland assessment, Schirmer I test. All the tests were conducted in the same area. RESULTS According to the ocular surface disease index, the rate of dry eye symptoms was significantly higher among operating room nurses than among outpatient nurses (70.5% vs 41.1%). Severe dry eye symptoms were more common in the operating room group. The meibomian gland score was higher in the operating room group (29.4% vs 5.9%). The numbers of blinks (30.91 ± 12.81 vs 21.05 ± 7.77) and incomplete blinks (8.76 ± 4.68 vs 5.76 ± 3.20) at rest were higher in operating room nurses. CONCLUSION The occupational risk for DED was high among operating room staff. National and international standards for the prevention and management of DED in personnel involved in health care services are needed.
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Affiliation(s)
- Selcan Ekicier Acar
- Eye Clinic, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, Turkey
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10
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Eom Y, Jun I, Jeon HS, Lim DH, Lee H, Hwang HS, Chung SH, Chung TY, Kim JY, Kim SW, Choi CY, Song JS, Kim MK, Seo KY, Hyon JY. Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:617-624. [PMID: 38753336 PMCID: PMC11099841 DOI: 10.1001/jamaophthalmol.2024.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 05/19/2024]
Abstract
Importance Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations. Objectives To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD. Design, Setting, and Participants This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily. Interventions rTG ω-3 Fatty acid supplementation vs grape-seed oil. Main Outcome Measures The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change. Results A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was -20.5 (16.0) and -22.7 (15.7), respectively, in the ω-3 group and -15.1 (20.2) and -18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = -5.4; 95% CI, -12.15 to 1.33; P = .12 and at 12 weeks = -3.9; 95% CI, -10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group. Conclusions and Relevance This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD. Trial Registration CRIS Identifier: KCT0004927.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hyang Chung
- Department of Ophthalmology, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Republic of Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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11
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Chang YM, Weng TH, Chien CC, Chen YH, Liang CM, Tai MC. Prevalence of meibomian gland dysfunction at a tertiary centre in Taiwan. Clin Exp Optom 2024; 107:515-521. [PMID: 37766425 DOI: 10.1080/08164622.2023.2246129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/05/2023] [Indexed: 09/29/2023] Open
Abstract
CLINICAL RELEVANCE Meibomian gland dysfunction and dry eye disease are closely related conditions that often coexist and can contribute to the development of each other. Understanding the similarities and differences between these diseases can assist clinicians in implementing effective treatments for both conditions in a clinical setting. BACKGROUND Dry eye disease is a multifactorial disease of the tears and ocular surface. This study aimed to evaluate the demographic characteristics of patients with meibomian gland dysfunction in Taiwan, investigate the association between meibomian gland dysfunction and dry eye parameters, and estimate the prevalence of meibomian gland dysfunction among patients with dry eye symptoms at a tertiary referral centre. METHODS This cross-sectional study enrolled patients aged ≥20 years who complained of dry eye symptoms and visited a tertiary centre between September 2019 and March 2020. The patients completed the Ocular Surface Disease Index and Standard Patient Evaluation of Eye Dryness questionnaires before undergoing ocular examination. The lipid layer thickness and meiboscale scores were recorded. In addition, the study measured tear film break-up time, examined corneal staining, and evaluated the number of meibomian glands yielding liquid secretions using a slit lamp. RESULTS The study evaluated 202 eyes of 202 patients with a mean age of 58.05 ± 13.34 years. The prevalence of meibomian gland dysfunction was 93%. Mean meiboscale score and age were negatively associated, and tear film break-up time was positively associated with the mean number of meibomian glands yielding liquid secretions. Hyperlipidaemia and smoking were the main risk factors for Meibomian gland dysfunction. CONCLUSIONS The prevalence of meibomian gland dysfunction among patients with dry eye symptoms was extremely high at the tertiary centre, highlighting the strong relationship between Meibomian gland dysfunction and dry eye disease. Clinicians should consider meibomian gland dysfunction as a possible cause of dry eye.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
| | - Chien-Cheng Chien
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
| | - Chang-Min Liang
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-service General Hospital, National Defense Medical Centre, Taipei City, Taiwan
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12
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Liu Y, Duan Z, Yuan J, Xiao P. Imaging assessment of conjunctival goblet cells in dry eye disease. Clin Exp Ophthalmol 2024; 52:576-588. [PMID: 38553944 DOI: 10.1111/ceo.14379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 07/03/2024]
Abstract
Dry eye disease (DED) is a widespread, multifactorial, and chronic disorder of the ocular surface with disruption of tear film homeostasis as its core trait. Conjunctival goblet cells (CGCs) are specialised secretory cells found in the conjunctival epithelium that participate in tear film formation by secreting mucin. Changes in both the structure and function of CGCs are hallmarks of DED, and imaging assessment of CGCs is important for the diagnosis, classification, and severity evaluation of DED. Existing imaging methods include conjunctival biopsy, conjunctival impression cytology and in vivo confocal microscopy, which can be used to assess the morphology, distribution, and density of the CGCs. Recently, moxifloxacin-based fluorescence microscopy has emerged as a novel technique that enables efficient, non-invasive and in vivo imaging of CGCs. This article presents a comprehensive overview of both the structure and function of CGCs and their alterations in the context of DED, as well as current methods of CGCs imaging assessment. Additionally, potential directions for the visual evaluation of CGCs are discussed.
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Affiliation(s)
- Yushuang Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Centre for Ocular Diseases, Guangzhou, China
| | - Zhengyu Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Centre for Ocular Diseases, Guangzhou, China
| | - Jin Yuan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Centre for Ocular Diseases, Guangzhou, China
| | - Peng Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Centre for Ocular Diseases, Guangzhou, China
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13
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Maehara H, Mukai R, Iitaka Y, Sekiryu T. Efficacy of 3% diquafosol long-acting eye drops in dry eye patients treated for three months. Jpn J Ophthalmol 2024; 68:338-345. [PMID: 38795194 DOI: 10.1007/s10384-024-01069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/10/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To investigate changes in the ocular surface and subjective symptoms during a three months administration of 3% diquafosol long-acting (DQL) eye drops. STUDY DESIGN Prospective observational study. METHODS DQL eye drops were administered as the sole treatment for all patients, including those in the group where DQL eye drops were newly prescribed (New DQL) and the group who switched from 3% diquafosol (DQS) eye drops (Switched DQL) in this prospective study. Each group underwent assessment of tear meniscus height (TMH), ocular surface disease index (OSDI), fluorescein break-up time (FBUT), fluorescein score, and Schirmer 1 test before DQL administration, at one month, and at three months. Changes in ocular surface scores and subjective symptoms at each time point were analyzed. RESULTS The study included a total of 63 eyes of 63 patients, with a mean age of 60.3 ±14.6 (SD). Among them, 29 patients (20 women) were in the New DQL group, and 34 patients (24 women) were in the Switched DQL group. Both the New DQL and Switched DQL groups showed significant improvements in TMH, OSDI, FBUT, Fluorescein Score, and Schirmer 1 test after three months of DQL eye drop administration. CONCLUSION DQL eye drops have the potential to improve ocular scores and subjective symptoms in patients with DE over a three months period, regardless of whether it is newly initiated or as a switch from DQS eye drops.
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Affiliation(s)
- Hiroki Maehara
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Yusuke Iitaka
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan.
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14
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Vasović DD, Karamarković ML, Jovanović M, Stojičić M, Kalezić T, Colić M, Musić N, Dragišić M, Jeremić M, Rašić DM, Marjanović I. Gender-Related Differences in Dry Eye Symptoms Following Involutional Ectropion and Entropion Surgery. Life (Basel) 2024; 14:815. [PMID: 39063570 PMCID: PMC11277694 DOI: 10.3390/life14070815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
This prospective case-control study investigated gender-related differences in dry eye symptoms following surgery for involutional ectropion and entropion. A total of 109 patients, aged between 65 and 89, were categorized by eyelid condition and gender. Postoperative assessments included the Tear Film Break-Up Time (TBUT) test, Schirmer I test results, corneal and conjunctival staining, eyelid margin characteristics, and scores from the Ocular Surface Disease Index (OSDI) questionnaire. The analysis revealed notable gender-related differences in dry eye manifestations. Initially, men exhibited lower TBUT scores but higher Schirmer test readings compared to women; however, these disparities diminished over time. No significant gender differences were detected in corneal and conjunctival staining, indicating similar levels of ocular surface damage across genders. Males showed significantly higher values in several eyelid margin characteristics (LMI, LMT) at various postoperative time points. According to the OSDI questionnaire, women experienced more severe symptoms of dry eye both pre- and post-operatively, suggesting a greater subjective symptom burden. When comparing surgical outcomes for ectropion and entropion, both conditions showed improvement in eyelid positioning and dry eye symptoms post-surgery. Despite these improvements, women with either condition reported more severe dry eye symptoms compared to men throughout the postoperative period. This study highlights the gender-specific variations in dry eye symptoms following eyelid malformation surgery and emphasizes the importance of adopting gender-sensitive approaches in postoperative care to improve outcomes and ocular health.
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Affiliation(s)
- Dolika D Vasović
- University Eye Hospital Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Lj Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Tanja Kalezić
- University Eye Hospital Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | | | | | - Milan Dragišić
- Clinic of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miroslav Jeremić
- University Eye Hospital Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejan M Rašić
- University Eye Hospital Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Ivan Marjanović
- University Eye Hospital Clinical Centre of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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15
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Ouyang XW, Fang S, Yi YM, Zou SP, Hu QY, Huang ZX, Li QX, Luo JY. Different concentrations of hyaluronic acid eye drops for dry eye syndrome: a systematic review and Meta-analysis. Int J Ophthalmol 2024; 17:1110-1119. [PMID: 38895674 PMCID: PMC11144765 DOI: 10.18240/ijo.2024.06.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/02/2024] [Indexed: 06/21/2024] Open
Abstract
AIM To compare high or low concentration of hyaluronic acid eye drops (HY) for dry eye syndromes (DES). METHODS Randomized controlled trials (RCTs) comparing various concentrations of HY were searched in PubMed, Embase, Web of Science, Cochrane, SinoMed, CNKI, Wanfang Database, CQVIP, and Chinese journals databases between inception and July 2023. Pooled standardized mean differences (SMD) or weighted mean difference (WMD) with 95% confidence intervals (CI) from RCTs evaluating Schirmer's I test (SIT), corneal fluorescein staining score (CFS), tear breakup time (TBUT), DES score (DESS), and Ocular Surface Disease Index (OSDI) were calculated. Sensitivity analysis, Egger's test and Meta-regression analysis were performed for all indicators. RESULTS We conducted a Meta-analysis of 10 RCTs that met the inclusion criteria, involving 1796 cases. High-concentrations group significantly improved the outcome of CFS according to random effects modelling (SMD, -3.37; 95%CI, -5.25 to -1.48; P=0.0005). The rest of the results were not statistically significant, including indicators such as SIT, TBUT, DESS and OSDI. CONCLUSION For dry eyes with positive corneal staining, a high concentration of HY is recommended, whereas in other cases, a high concentration of HY does not offer a more pronounced advantage over a low concentration of HY in the treatment of dry eyes.
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Affiliation(s)
- Xiao-Wei Ouyang
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Sheng Fang
- Department of Ophthalmology, Jiangxi Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 330000, Jiangxi Province, China
| | - Yun-Min Yi
- Department of Cataract, Nanchang University Affiliated Eye Hospital, Nanchang 330000, Jiangxi Province, China
| | - Shi-Peng Zou
- Department of Neuro-ophthalmology, Nanchang University Affiliated Eye Hospital, Nanchang 330000, Jiangxi Province, China
| | - Qi-Yu Hu
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Zi-Xuan Huang
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Qing-Xia Li
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
| | - Jin-Yan Luo
- Department of Ophthalmology, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang 330000, Jiangxi Province, China
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16
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Tang N, Tang L, Lyu J, Jiang X, Li Y, Ding C, Xiang S. Effect of Acupuncture on Tear Proteomics in Patients with Video Display Terminal-Related Dry Eye. J Proteome Res 2024; 23:2206-2218. [PMID: 38723043 PMCID: PMC11165574 DOI: 10.1021/acs.jproteome.4c00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 06/13/2024]
Abstract
Acupuncture is widely used to treat dry eye disease (DED), but its effect has not been reported in treating video display terminal (VDT)-related dry eye, and the mechanism of acupuncture on VDT-related dry eye is also unknown. In our study, the tear proteome was compared with identifying possible mechanisms and biomarkers for predicting acupuncture effectiveness in VDT-related dry eye. The results showed that the ocular surface disease index scores were significantly different between the acupuncture group (AC group) and artificial tears group (AT group) at the end of the study, whereas tear film breakup time (TFBUT) and Schirmer I test (SIT) were not significantly different between the groups. Proteome changes pre- and post-treatment in the AC group were associated with B cell-related immune processes, inflammation, glycolysis, and actin cytoskeleton. Furthermore, the proteins hexosaminidase A and mannose-binding lectin 1 could prospectively predict whether acupuncture treatment was effective. Therefore, we believe that acupuncture can provide greater improvement in the clinical symptoms of VDT-related dry eye than artificial tears. The mechanism of acupuncture in VDT-related dry eye treatment may be associated with glycolysis- and actin cytoskeleton remodeling-mediated inflammatory and immune processes. Additionally, hexosaminidase A and mannose-binding lectin 1 are biomarkers for predicting the efficacy of acupuncture for VDT-related dry eye.
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Affiliation(s)
- Na Tang
- National
Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lewei Tang
- National
Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Jiacheng Lyu
- State
Key Laboratory of Genetic Engineering and Collaborative Innovation
Center for Genetics and Development, School of Life Sciences, Institutes
of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai 200433, China
| | - Xiaohan Jiang
- National
Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yan Li
- National
Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Chen Ding
- State
Key Laboratory of Genetic Engineering and Collaborative Innovation
Center for Genetics and Development, School of Life Sciences, Institutes
of Biomedical Sciences, Human Phenome Institute, Zhongshan Hospital, Fudan University, Shanghai 200433, China
| | - Shengjin Xiang
- National
Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
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17
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Hsieh HH, Chang YA, Chan S, Lin ZQ, Lin CT, Hu FR, Hung KF, Sun YC. Characterizing the Robustness of Distinct Clinical Assessments in Identifying Dry Eye Condition of Animal Models. Curr Eye Res 2024; 49:565-573. [PMID: 38299568 DOI: 10.1080/02713683.2024.2310614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
PURPOSE The study aims to characterize the robustness of distinct clinical assessments in identifying the underlying conditions of dry eye disease (DED), with a specific emphasis on the involvement of conjunctival goblet cells. METHODS Seven rabbits receiving surgical removal of the lacrimal and Harderian glands were divided into two groups, one with ablation of conjunctival goblet cells by topical soaking of trichloroacetic acid (TCA) to the bulbar conjunctiva (n = 3) and one without (n = 4), and the conditions of DED were assessed weekly using Schirmer test, tear breakup time (TBUT), tear osmolarity, and National Eye Institute (NEI) fluorescein staining grading. After 8 weeks, the rabbits were sacrificed, and the eyes were enucleated for histopathological examination. RESULTS Histopathological analysis revealed corneal epithelial thinning in both groups. While TCA soaking significantly decreased the density of conjunctival goblet cells, DED rabbits without TCA also showed a partial reduction in goblet cell density, potentially attributable to dacryoadenectomy. Both groups showed significant decreases in Schirmer test and TBUT, as well as an increase in tear osmolarity. In DED rabbits with TCA soaking, tear osmolarity increased markedly, suggesting that tear osmolarity is highly sensitive to loss and/or dysfunction of conjunctival goblet cells. Fluorescein staining was gradually and similarly increased in both groups, suggesting that fluorescein staining may not reveal an early disruption of the tear film until the prolonged progression of DED. CONCLUSION The Schirmer test, TBUT, tear osmolarity, and NEI fluorescein grading are distinct, yet complementary, clinical assessments for the evaluation of DED. By performing these assessments in definitive DED rabbit models, both with and without ablation of conjunctival goblet cells, the role of these cells in the homeostasis of tear osmolarity is highlighted. Characterizing the robustness of these assessments in identifying the underlying conditions of DED will guide a more appropriate management for patients with DED.
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Affiliation(s)
- Hsiu-Hui Hsieh
- Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Yu-An Chang
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Szemin Chan
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Zhi-Qian Lin
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Tien Lin
- Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kai-Feng Hung
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Dentistry, School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chen Sun
- Department of Ophthalmology, Taipei Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu-Chi University, Hualien, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
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18
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Maulvi FA, Desai DT, Kalaiselvan P, Dumpati S, Kuppusamy R, Masoudi S, Shah DO, Willcox MDP. Lipid-based eye drop formulations for the management of evaporative dry eyes. Cont Lens Anterior Eye 2024; 47:102154. [PMID: 38523013 DOI: 10.1016/j.clae.2024.102154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/01/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
Dry eye disease is a progressive prevalent ocular surface disorder that arises from various factors and is characterized by insufficient quality and/or quantity of tears. The underlying pathophysiology is intricate and can progress to chronic, difficult-to-treat conditions. Multiple strategies and therapeutic approaches are utilized in its management that target one or more etiopathological components of dry eyes, which may include aqueous tear deficiency or evaporative dry eyes. The primary focus of this paper is on treatment alternatives that utilize lipids for the treatment of evaporative dry eyes. This may arise from either abnormal lipid production or inadequate lipid spreading caused by meibomian gland dysfunction. The hypothesis behind the development of these lipid-containing eye drops is that if they can imitate the lipid layer, they may be able to help in the management of the signs and symptoms of evaporative dry eyes. The lipids used in commercial formulations for dry eyes are mineral oil, castor oil, phospholipids, omega-3 fatty acid, and medium-chain triglycerides. The literature suggests the potential of lipid-containing eye drops to alleviate some of the signs and symptoms and enhance the quality of life for individuals suffering from evaporative dry eyes.
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Affiliation(s)
- Furqan A Maulvi
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales 2052, Australia; Maliba Pharmacy College, Uka Tarsadia University, Surat 394350, India.
| | - Ditixa T Desai
- Maliba Pharmacy College, Uka Tarsadia University, Surat 394350, India
| | - Parthasarathi Kalaiselvan
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Srikanth Dumpati
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Rajesh Kuppusamy
- Faculty of Science, School of Chemistry, The University of Sydney, New South Wales 2006, Australia
| | - Simin Masoudi
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Dinesh O Shah
- Department of Chemical Engineering and Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales 2052, Australia
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Kaido M, Arita R. Effects of a Long-Acting Diquafosol Ophthalmic Solution on the Ocular Surface, Tolerability, and Usability in Dry Eye Disease. Adv Ther 2024; 41:2477-2485. [PMID: 38709396 DOI: 10.1007/s12325-024-02871-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION This study aimed to investigate the tolerability of high-viscosity diquafosol tetrasodium (DQS) ophthalmic solution (DIQUAS LX; DQSLX) and examine its usability and effect on clinical findings in patients with dry eye disease (DED). METHODS This interventional retrospective study included 66 eyes of 66 patients with DED who switched from conventional DQS to DQSLX ophthalmic solution. Tear function assessments (tear film breakup time [BUT], keratoconjunctival vital staining [VS] score), evaluations of DED symptom relief, and a four-item usability questionnaire ("comfort upon instillation," "irritation upon instillation," "eye mucus discharge," "convenience of instillation frequency") assessed using a visual analog scale from 0 (worst) to 10 (best) were administered 4 weeks after switching to DQSLX. Factors associated with drug tolerability were assessed using multiple regression analysis. RESULTS The symptoms improved by 64.2% after switching to DQSLX. The BUT value, VS score, and the questionnaire items "comfort upon instillation" and "convenience of instillation frequency" were significantly improved after switching to DQSLX. DQSLX tolerability was reported as acceptable in 56 (84.8%) and unacceptable in 10 (15.2%) patients. Overall, DQSLX tolerability was significantly associated with "comfort upon instillation" and "convenience of instillation frequency" and tended to be associated with a VS score ≥ 1. DQSLX tolerability depended on symptom and VS score improvements and absence of excessive "eye mucus discharge" in patients with a VS score ≥ 1 (39 patients), but on "comfort upon instillation" and absence of excessive "eye mucus discharge" in patients with a VS score = 0 (27 patients). CONCLUSION The high-viscosity DQSLX ophthalmic solution was generally considered acceptable in the study population. However, drug tolerability seemingly differed between patients with DED with and without epithelial damage. The former were affected by improvements in symptoms and clinical findings, whereas the latter were affected by comfort upon instillation. TRIAL REGISTRATION University Hospital Medical Information Network identifier, UMIN000051390.
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Affiliation(s)
- Minako Kaido
- Wada Eye Clinic, Houjyo 2578-27, Tateyama-shi, Chiba, 294-0045, Japan.
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Shen J, Xu Z, Wang Y, Ye J, Wei L, Xia J, Sun Y, Lu F, Hu L. Influential Signs of Dry Eye-Related Ocular Symptoms in Participants With Unstable Tear Film. Cornea 2024; 43:751-756. [PMID: 38285962 DOI: 10.1097/ico.0000000000003473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
PURPOSE The aim of this study was to investigate the factors influencing dry eye disease (DED)-related ocular symptoms in participants with short fluorescein tear break-up time (FTBUT). METHODS This cross-sectional study included 82 participants with short FTBUT (<10 seconds). Examinations included Ocular Surface Disease Index (OSDI), FTBUT, average noninvasive tear break-up time (NIBUTave), lid wiper epitheliopathy, lipid layer thickness, blink rate, partial blink, tear meniscus height, and meibomian gland (MG) evaluation which included ratio of residual MG area (RMGA) and MG grade in tarsal plates. One-way analysis of variance was used to detect differences between symptomatic tear film instability group (FTBUT <5 s, OSDI ≥13), asymptomatic tear film instability group (FTBUT <5 s, OSDI <13), and control group (FTBUT ≥5 s, OSDI <13). A bivariate correlation, partial correlation, and multiple linear regression analyses were used to identify major factors. Only the right eye was included. RESULTS Among the participants with FTBUT <5 seconds, symptomatic group showed less upper RMGA ( P < 0.001) and NIBUTave ( P = 0.010). OSDI was negatively associated with upper RMGA ( r = -0.450, P < 0.001) and NIBUTave ( r = -0.414, P = 0.001), and positively associated with upper MG grade ( r = 0.277, P = 0.027). Linear regression analysis showed that the upper RMGA significantly affected OSDI (B = -41.895, P = 0.001), while not significantly correlated with age, upper MG grade, and NIBUTave. CONCLUSIONS The upper RMGA might be the main factor affecting DED-related discomfort in participants with unstable tear film, indicating an early ocular change in DED.
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Affiliation(s)
- Jiahui Shen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Zhiqiang Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yuzhou Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jingjian Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Linzhi Wei
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jiahui Xia
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yiran Sun
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fan Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Liang Hu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China; and
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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21
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Wei W, Cao H, Shen D, Sun X, Jia Z, Zhang M. Antioxidant Carbon Dots Nanozyme Loaded in Thermosensitive in situ Hydrogel System for Efficient Dry Eye Disease Treatment. Int J Nanomedicine 2024; 19:4045-4060. [PMID: 38736656 PMCID: PMC11088389 DOI: 10.2147/ijn.s456613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/30/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose Dry eye disease (DED) is a multifactorial ocular surface disease with a rising incidence. Therefore, it is urgent to construct a reliable and efficient drug delivery system for DED treatment. Methods In this work, we loaded C-dots nanozyme into a thermosensitive in situ gel to create C-dots@Gel, presenting a promising composite ocular drug delivery system to manage DED. Results This composite ocular drug delivery system (C-dots@Gel) demonstrated the ability to enhance adherence to the corneal surface and extend the ocular surface retention time, thereby enhancing bioavailability. Furthermore, no discernible ocular surface irritation or systemic toxicity was observed. In the DED mouse model induced by benzalkonium chloride (BAC), it was verified that C-dots@Gel effectively mitigated DED by stabilizing the tear film, prolonging tear secretion, repairing corneal surface damage, and augmenting the population of conjunctival goblet cells. Conclusion Compared to conventional dosage forms (C-dots), the C-dots@Gel could prolong exhibited enhanced retention time on the ocular surface and increased bioavailability, resulting in a satisfactory therapeutic outcome for DED.
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Affiliation(s)
- Wei Wei
- School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, People’s Republic of China
- Xi’an No.1 Hospital, Shaanxi Institute of Ophthalmology, Shaanxi Key Laboratory of Ophthalmology, Clinical Research Center for Ophthalmology Diseases of Shaanxi Province, First Affiliated Hospital of Northwestern University, Xi’an, Shaanxi, 710002, People’s Republic of China
| | - Haili Cao
- Xi’an No.1 Hospital, Shaanxi Institute of Ophthalmology, Shaanxi Key Laboratory of Ophthalmology, Clinical Research Center for Ophthalmology Diseases of Shaanxi Province, First Affiliated Hospital of Northwestern University, Xi’an, Shaanxi, 710002, People’s Republic of China
| | - Di Shen
- Xi’an No.1 Hospital, Shaanxi Institute of Ophthalmology, Shaanxi Key Laboratory of Ophthalmology, Clinical Research Center for Ophthalmology Diseases of Shaanxi Province, First Affiliated Hospital of Northwestern University, Xi’an, Shaanxi, 710002, People’s Republic of China
| | - Xiyu Sun
- Xi’an No.1 Hospital, Shaanxi Institute of Ophthalmology, Shaanxi Key Laboratory of Ophthalmology, Clinical Research Center for Ophthalmology Diseases of Shaanxi Province, First Affiliated Hospital of Northwestern University, Xi’an, Shaanxi, 710002, People’s Republic of China
| | - Zhenzhen Jia
- School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, People’s Republic of China
| | - Mingzhen Zhang
- School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, 710061, People’s Republic of China
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22
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Tan X, Chen Q, Chen Z, Sun Z, Chen W, Wei R. Mitochondrial DNA-Activated cGAS-STING Signaling in Environmental Dry Eye. Invest Ophthalmol Vis Sci 2024; 65:33. [PMID: 38648040 PMCID: PMC11044830 DOI: 10.1167/iovs.65.4.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/17/2024] [Indexed: 04/25/2024] Open
Abstract
Purpose The cGAS-STING pathway has been shown to be an important mediator of inflammation. There is emerging evidence of the importance of this signaling cascade in a variety of inflammatory diseases settings. Here, we present evidence that the mitochondrial DNA (mtDNA) damage-mediated cGAS-STING pathway plays an important role in the induction of inflammation in environmental dry eye (DE). Methods RT-qPCR and Western blot were used to assess the induction of the cGAS-STING pathway and inflammatory cytokines in environmental DE mouse model, primary human corneal epithelial cells (pHCECs), and patients with DE. RNA sequencing was used to determine mRNA expression patterns of high osmotic pressure (HOP)-stimulated pHCECs. mtDNA was detected with electron microscopy, flow cytometry, and immunofluorescent staining. mtDNA was isolated and transfected into pHCECs for evaluating the activation of the cGAS-STING pathway. Results The expression levels of cGAS, STING, TBK1, IRF3, and IFNβ were significantly increased in an environmental DE model and HOP-stimulated pHCECs. The STING inhibitor decreased the expression of inflammatory factors in DE. An upregulation of STING-mediated immune responses and IRF3 expression mediated by TBK1 were observed in the HOP group. HOP stimulation induced mitochondrial oxidative damage and the leakage of mtDNA into the cytoplasm. Then, mtDNA activated the cGAS-STING pathway and induced intracytoplasmic STING translocated to the Golgi apparatus. Finally, we also found activated cGAS-STING signaling in the human conjunctival blot cell of patients with DE. Conclusions Our findings suggest that the cGAS-STING pathway is activated by recognizing cytoplasmic mtDNA leading to STING translocation, further exacerbating the development of inflammation in environmental DE.
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Affiliation(s)
- Xiying Tan
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianqian Chen
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhonghua Chen
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenzhen Sun
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Chen
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruifen Wei
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Tian L, Jin X, Wang J, Xu Y, Lu C, Zhao S, Zhu Q, Dai H, Gu H, Zhang M, Wang L, Lu X, Ma L, Zhu L, Zeng Q, Zhang H, Fu Y, Li S, Tao L, Ren Q, Ding F, Zhang S, Zhu S, Li Z, Jie Y. Varenicline solution nasal spray for dry eye disease in Chinese patients: a randomized phase 3 trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:101032. [PMID: 38440130 PMCID: PMC10909742 DOI: 10.1016/j.lanwpc.2024.101032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/18/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024]
Abstract
Background Dry eye disease has a high prevalence and exerts a significant negative effect on quality of life. In China, there are currently no available nasal sprays to promote natural tear production in patients with dry eye disease. We therefore evaluated the efficacy and safety of OC-01 (varenicline solution) nasal spray versus vehicle in Chinese patients with dry eye disease. Methods This was a randomized, multicenter, double-masked, vehicle-controlled, phase 3 clinical trial conducted at ophthalmology departments in 20 hospitals across China (NCT05378945). Eligible patients had a diagnosis of dry eye disease based on patient symptoms, Eye Dryness Score (EDS), Schirmer's Test (with topical anesthesia) Score (STS), and corneal fluorescein staining (CFS) score. Participants were randomly assigned 1:1 using an Interactive Web Response System (IWRS) to receive OC-01 0.6 mg/mL twice daily (BID) or vehicle nasal spray. Participants, investigators, and sponsor were all masked to treatment assignment. The primary endpoint was the percentage of subjects in the intention-to-treat population achieving ≥10 mm improvement in STS from baseline at week 4. Findings In total, 340 patients were randomized from 21 July 2022 to 04 April 2023, 78.8% were female. Patients in the OC-01 group (n = 176) had significantly higher achievement of ≥10 mm improvement in STS (35.8% [n = 63] versus 17.7% [n = 29], stratified odds ratio: 2.67, 95% CI: 1.570-4.533, p = 0.0002) and a significantly greater increase from baseline STS (least-squares mean difference [SE]: 3.87 [0.794], p < 0.0001) at week 4 versus the vehicle group (n = 164). In addition, OC-01 led to a numerically greater reduction in mean EDS from baseline at week 4 compared to the vehicle group (LS mean [SE] difference: -1.3 [2.20]; 95% CI: -5.64 to 2.99, p = 0.5467). The most common adverse event was mild, transient sneezing (78% of OC-01 administrations). No serious adverse events related to nasal administration occurred. Interpretation OC-01 (varenicline solution) nasal spray BID has clinically meaningful efficacy for reducing the signs (as measured by STS) and may improve the symptoms (as measured by EDS) of dry eye disease, with an excellent safety and tolerability profile, in the Chinese population. Funding Jixing Pharmaceutical Co. Ltd.
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Affiliation(s)
- Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Xiuming Jin
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jibing Wang
- Department of Ophthalmology, Weifang Eye Hospital, Shandong, China
| | - Yonggen Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Chengwei Lu
- Department of Ophthalmology, Bethune First Hospital of Jilin University, Changchun, China
| | - Shaozhen Zhao
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Qian Zhu
- Department of Ophthalmology, Tongji Hospital of Tongji University, Shanghai, China
| | - Hong Dai
- Department of Ophthalmology, Beijing Hospital, Beijing, China
| | - Hao Gu
- Department of Ophthalmology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Mingchang Zhang
- Department of Ophthalmology, Union Hospital Tongji Medical College Huazhong University of Science and Technology, Hubei, China
| | - Linnong Wang
- Department of Ophthalmology, Nanjing First Hospital, Nanjing, China
| | - Xiaohe Lu
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangdong, China
| | - Lixiao Ma
- Department of Corneal, Hebei Eye Hospital, Xing Tai, China
| | - Lei Zhu
- Department of Ophthalmology, Henan Eye Hospital, Henan Provincial People's Hospital, Zhengzhou, China
| | - Qingyan Zeng
- Department of Ophthalmology, Wuhan Aier Eye Hospital Hankou Hospital, Hubei, China
| | - Hong Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yao Fu
- Department of Ophthalmology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Suxia Li
- Department of Ophthalmology, Eye Hospital of Shandong First Medical University, Shandong, China
| | - Liming Tao
- Department of Ophthalmology, The Second Hospital of Anhui Medical University, Anhui, China
| | - Qian Ren
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Faming Ding
- Jixing Pharmaceutical Co Ltd., Shanghai, China
| | | | - Shaopin Zhu
- Jixing Pharmaceutical Co Ltd., Shanghai, China
| | - Zhiping Li
- Jixing Pharmaceutical Co Ltd., Shanghai, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
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Kim DH, Eom Y, Yoon CH, Lee HS, Hwang HS, Kim JH, Kim TI, Song JS, Seo KY, Yoon KC, Society KDE. New Korean Guidelines for the Diagnosis and Management of Dry Eye Disease. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:156-163. [PMID: 38433323 PMCID: PMC11016685 DOI: 10.3341/kjo.2023.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: "Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms." The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.
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Affiliation(s)
- Dong Hyun Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul,
Korea
| | - Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul,
Korea
| | - Chang Ho Yoon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyun Soo Lee
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | | | - Tae-im Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul,
Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul,
Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju,
Korea
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Shahraki T, Baradaran-Rafii A, Ayyala R, Arabi A, Jarstad J, Memar F. New advances in medical management of dry eye: optimizing treatment strategies for enhanced relief. Int Ophthalmol 2024; 44:49. [PMID: 38337030 DOI: 10.1007/s10792-024-02978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 10/29/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE Dry eye disease (DED) is a prevalent ocular surface disease that is conventionally characterized by tear film hyperosmolarity and instability. This review presents a summarized classification of DED, followed by a comprehensive discussion of the most recent topical and systemic medications and clinical recommendations for selecting the most appropriate option for each patient. METHODS An extensive literature search was conducted on electronic databases, such as PubMed, Scopus, and Web of Science, using keywords including "dry eye syndrome," "ocular surface disease," "medical management," "artificial tears," "topical immunomodulators," and "meibomian gland dysfunction." RESULTS The underlying reasons for DED can range from insufficient aqueous tear production to increased tear evaporation. Recent literature has provided a more in-depth understanding of the pathophysiology of DED by examining the tear film's lipid, aqueous, and mucin layers. However, despite these advancements, medical management of patients with symptomatic DED has not fully reflected this modernized knowledge of its pathophysiology. CONCLUSION To develop a rationalized strategy for treating DED, it is crucial to have updated knowledge of therapeutic options, their mechanisms of actions, and indications based on the DED type and underlying causes.
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Affiliation(s)
- Toktam Shahraki
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Boostan 9 St., Pasdaran Ave, Tehran, Iran.
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Ramesh Ayyala
- Department of Ophthalmology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Amir Arabi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, No. 23, Paidarfard St., Boostan 9 St., Pasdaran Ave, Tehran, Iran
| | - John Jarstad
- Department of Ophthalmology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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Koh S. Galápagosization: Diquafosol for Dry Eyes. Eye Contact Lens 2024; 50:57-58. [PMID: 38284907 DOI: 10.1097/icl.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan; and Department of Ophthalmology (S.K.), Osaka University Graduate School of Medicine, Osaka, Japan
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Zhao L, Yu JJ, Liu Y, Zuo T, Zhou H, Ju P, Li Y, Cao Y, Dong B. An enhanced model for environmental dry eye: Exploring pathological features and underlying factors. Exp Eye Res 2024; 239:109744. [PMID: 38072354 DOI: 10.1016/j.exer.2023.109744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/17/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023]
Abstract
This study aimed to develop an enhanced environmental dry eye (EDE) model that accurately reproduces the etiology of prolonged visual fatigue and investigates the underlying pathological features. A total of 40 adult SPF-grade Wistar rats were randomly assigned to control (n = 20) and model (n = 20) groups. Rats in the control group were maintained under normal conditions, while rats in the model group were exposed to a controlled frontal airflow of 2-4 m/s from a fan for 7.5 h daily while placed on a suspended cylindrical wire mesh frame. Various assessments were performed at different time points during the 14-day experiment, including blink frequency, tear secretion (phenol red thread test), tear film breakup time (BUT), fluorescein staining (FL), corneal epithelial status (light microscopy), ultrastructure of corneal epithelial cells (electron microscopy), and expression levels of inflammatory cytokines (IL-1β, TNF-α) in tears (enzyme-linked immunosorbent assay). Additionally, mRNA and protein expression levels of MMP-9, IL1β, IL6, TNF-α, IFN-γ, and caspase-3 in corneal tissues were quantified (real-time quantitative PCR and Western blotting). Compared to the control group, the model group rats exhibited significant decreases in blink frequency (P < 0.001), tear secretion (Schirmer I test) values (P < 0.001), and tear film breakup time levels (P < 0.001). There was also a significant increase in fluorescein staining scores (P < 0.001) in the model group. Histological examination revealed distinct differences of the corneal epithelium between groups. The corneal epithelium of the model group appeared thicker, with disorganized cell arrangement in the superficial and basal layers, partial defects or detachment of superficial epithelial cells, and a rough, uneven surface. Scanning electron microscopy observations showed a rough corneal epithelial surface with numerous cracks and scattered vesicular-like structures in the model group. Furthermore, the model group rats exhibited a significant increase in expression of IL-1β and TNF-α in tears (P < 0.001), and upregulated expression levels of MMP-9, TNF-α, IL-1β, caspase-3, IL-6, and IFN-γ at both the mRNA and protein levels in corneal tissues (P < 0.001). In conclusion, the modified "wire-meshing cylindrical board" model effectively overcomes the limitations of the traditional "jogging board " dry eye model and successfully simulates the etiology of prolonged visual fatigue. This innovative EDE model demonstrates a high degree of relevance to dry eye conditions resulting from prolonged visual tasks, with a high success rate of model induction. Moreover, it proves to be a simple, practical, and easily replicable model, making it highly suitable for further studies on prolonged visual fatigue and facilitating its widespread adoption in research and clinical applications.
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Affiliation(s)
- Lei Zhao
- Liaoning University of Traditional Chinese Medicine, China; Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China
| | - Jj Jiajia Yu
- Liaoning University of Traditional Chinese Medicine, China
| | - Yulin Liu
- Liaoning University of Traditional Chinese Medicine, China
| | - Tao Zuo
- Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China
| | - Huimin Zhou
- Liaoning University of Traditional Chinese Medicine, China
| | - Pin Ju
- Liaoning University of Traditional Chinese Medicine, China
| | - Yuexin Li
- Liaoning University of Traditional Chinese Medicine, China
| | - Yingyue Cao
- Liaoning University of Traditional Chinese Medicine, China
| | - Baoqiang Dong
- Liaoning University of Traditional Chinese Medicine, China.
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Pena-Verdeal H, Garcia-Queiruga J, Sabucedo-Villamarin B, Garcia-Resua C, Giraldez MJ, Yebra-Pimentel E. A Comprehensive Study on Tear Meniscus Height Inter-Eye Differences in Aqueous Deficient Dry Eye Diagnosis. J Clin Med 2024; 13:659. [PMID: 38337353 PMCID: PMC10856492 DOI: 10.3390/jcm13030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Dry eye disease (DED) is a chronic ocular surface condition that requires precise diagnostic tools. The present study aimed to investigate the diagnostic potential of the absolute inter-eye difference (|OD-OS|) in tear meniscus height (TMH) for the detection of the presence of aqueous deficient dry eye (ADDE). (2) Methods: A sample of 260 participants with dry eye complaints underwent ocular surface examinations thorough diagnostic assessments based on the Tear Film and Ocular Surface Society guidelines (TFOS DEWS II). Participants were subsequently categorized as No ADDE and ADDE based on TMH. Statistical analyses to determine the optimal TMH|OD-OS| cut-off value in a randomly selected study group (200 participants) were performed, while a separate validation analysis of the cut-off value obtained in a random cross-validation group (60 participants) was also performed. (3) Results: The significant diagnostic capability of TMH|OD-OS| (area under the curve = 0.719 ± 0.036, p < 0.001) was found. The identified cut-off value of 0.033 mm demonstrated reliable specificity (77.6%) and moderate sensitivity (59.1%). Cross-validation confirmed the cut-off value's association with the TFOS DEWS II diagnostic criterion (Cramer's V = 0.354, p = 0.006). (4) Conclusions: The present study provides evidence for the diagnostic potential of TMH|OD-OS| in identifying ADDE. The identified cut-off value enhances the specificity and offers moderate sensitivity, providing an objective tool for clinical decision making.
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Affiliation(s)
- Hugo Pena-Verdeal
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Jacobo Garcia-Queiruga
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Belen Sabucedo-Villamarin
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
| | - Carlos Garcia-Resua
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Maria J. Giraldez
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Eva Yebra-Pimentel
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
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Maehara H, Norikawa K, Tanaka K, Kato Y, Kasai A, Mukai R, Omori T, Machida T, Sekine H, Sekiryu T. Complement activation products in tears of dry eye and meibomian gland dysfunction. Sci Rep 2024; 14:43. [PMID: 38168536 PMCID: PMC10761822 DOI: 10.1038/s41598-023-46634-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/03/2023] [Indexed: 01/05/2024] Open
Abstract
Sixty-seven patients (38 woman; median age, 69 years) were enrolled to assess complement activation products (CAPs) in tear fluid with/without dry eye (DE) and with/without meibomian gland dysfunction (MGD). Patients were divided into four groups based on the presence/absence of DE and MGD: group DM had both DE and MGD, group DN had DE without MGD, group NM had MGD without DE, and group NN had neither DE nor MGD. The levels of C3a and C5a in the collected tears were analyzed using a cytometric bead array. The C3a concentrations in the DM, DN, NM, and NN groups were 2326 pg/ml, 1411 pg/ml, 1821 pg/ml, and 978 pg/ml, respectively. The C5a concentrations in the DM, DN, NM, and NN groups were 24.7 pg/ml, 15.3 pg/ml, 24.1 pg/ml, and 12.9 pg/ml, respectively. The concentrations of C3a and C5a in the DM and NM groups were significantly higher than in the NN group (P < 0.05 for both comparisons). The CAPs in the tear fluid in MGD and DE increased. Local dysregulation of the innate immune system can be associated with the development of MGD and DE in elderly patients.
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Affiliation(s)
- Hiroki Maehara
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan.
| | - Koki Norikawa
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Keiichiro Tanaka
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Yutaka Kato
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Akihito Kasai
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Ryo Mukai
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan
| | - Tomoko Omori
- Department of Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeshi Machida
- Department of Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hideharu Sekine
- Department of Immunology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Tetsuju Sekiryu
- Department of Ophthalmology, Fukushima Medical University School of Medicine, Hikarigaoka 1, Fukushima, Fukushima, 960-1247, Japan.
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Yokoi N, Kusada N, Kato H, Furusawa Y, Sotozono C, Georgiev GA. Dry Eye Subtype Classification Using Videokeratography and Deep Learning. Diagnostics (Basel) 2023; 14:52. [PMID: 38201361 PMCID: PMC10802766 DOI: 10.3390/diagnostics14010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
We previously reported on 'Tear Film Oriented Diagnosis' (TFOD), a method for the dry eye (DE) subtype classification using fluorescein staining and an examination of fluorescein breakup patterns via slit-lamp biomicroscopy. Here, we report 'AI-supported TFOD', a novel non-invasive method for DE subtype classification using videokeratography (VK) and "Blur Value" (BV), a new VK indicator of the extent of blur in Meyer-ring images and deep learning (DL). This study involved 243 eyes of 243 DE cases (23 males and 220 females; mean age: 64.4 ± 13.9 (SD) years)-i.e., 31 severe aqueous-deficient DE (sADDE) cases, 73 mild-to-moderate ADDE (m/mADDE) cases, 84 decreased wettability DE (DWDE) cases, and 55 increased evaporation DE (IEDE) cases diagnosed via the fluorescein-supported TFOD pathway. For DL, a 3D convolutional neural network classification model was used (i.e., the original image and BV data of eyes kept open for 7 s were randomly divided into training data (146 cases) and the test data (97 cases), with the training data increased via data augmentation and corresponding to 2628 cases). Overall, the DE classification accuracy was 78.40%, and the accuracies for the subtypes sADDE, m/mADDE, DWDE, and IEDE were 92.3%, 79.3%, 75.8%, and 72.7%, respectively. 'AI-supported TFOD' may become a useful tool for DE subtype classification.
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Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (Y.F.); (C.S.)
| | - Natsuki Kusada
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (Y.F.); (C.S.)
| | - Hiroaki Kato
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (Y.F.); (C.S.)
| | - Yuki Furusawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (Y.F.); (C.S.)
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan; (N.K.); (H.K.); (Y.F.); (C.S.)
| | - Georgi As. Georgiev
- Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, 1164 Sofia, Bulgaria;
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Rasaruck U, Kasetsuwan N, Kittipibul T, Pongchaikul P, Chatsuwan T. Composition and diversity of meibum microbiota in meibomian gland dysfunction and the correlation with tear cytokine levels. PLoS One 2023; 18:e0296296. [PMID: 38134040 PMCID: PMC10745150 DOI: 10.1371/journal.pone.0296296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Meibomian gland dysfunction (MGD) leads to meibum stasis and pathogenic bacteria proliferation. We determined meibum microbiota via next-generation sequencing (NGS) and examined their association with tear cytokine levels in patients with MGD. This cross-sectional study included 44 moderate-severe patients with MGD and 44 healthy controls (HCs). All volunteers underwent assessment with the ocular surface disease index questionnaire, Schirmer without anesthesia, tear break-up time, Oxford grading of ocular surface staining, and lid and meibum features. Sample collection included tears for cytokine detection and meibum for 16S rRNA NGS. No significant differences were observed in the α-diversity of patients with MGD compared with that in HCs. However, Simpson's index showed significantly decreased α-diversity for severe MGD than for moderate MGD (p = 0.045). Principal coordinate analysis showed no significant differences in β-diversity in meibum samples from patients with MGD and HCs. Patients with MGD had significantly higher relative abundances of Bacteroides (8.54% vs. 6.00%, p = 0.015) and Novosphingobium (0.14% vs. 0.004%, p = 0.012) than the HCs. Significantly higher interleukin (IL)-17A was detected in the MGD group than in the HC group, particularly for severe MGD (p = 0.008). Although Bacteroides was more abundant in the MGD group than in the HC group, it was not positively correlated with IL-17A. The relationship between core meibum microbiota and tear cytokine levels remains unclear. However, increased Bacteroides and Novosphingobium abundance may be critical in MGD pathophysiology.
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Affiliation(s)
- Ubonwan Rasaruck
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanachaporn Kittipibul
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Pongchaikul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakarn, Thailand
- Integrative Computational Bioscience (ICBS) Center, Mahidol University, Nakorn Pathom, Thailand
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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32
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Ayaki M, Negishi K. Seasonality of Tear Meniscus Volume and Dry Eye-Related Symptoms - A Cross-Sectional Retrospective Cohort Study. Clin Ophthalmol 2023; 17:3809-3816. [PMID: 38105909 PMCID: PMC10725749 DOI: 10.2147/opth.s442567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose We aimed to determine the seasonal variation in the tear meniscus level on strip meniscometry and its association with ocular parameters and symptoms. In Japan, there are four distinct seasons characterized by marked differences in temperature and humidity, which may contribute to an observed seasonality of ocular surface symptoms. Methods We conducted a cross-sectional study in two Japanese clinics and recruited first-visit patients for 3 years. Tear strip meniscometry, tear break-up time (BUT), Schirmer test, and corneal staining were examined, and major ocular symptoms (dryness, irritation, pain, fatigue, blurred vision, and photophobia) were determined through interviews. Results The 1196 participants had a mean age of 58.9±15.2 years; 37.1% were of male sex. Strip meniscometry values and BUT revealed significant seasonality with one-way analysis of variance. The mean strip meniscometry value (mm) was 2.15±2.59 in spring (p=0.025 vs winter), 2.37±2.79 in summer (p<0.001), 2.38±2.80 in fall (p<0.001), and 1.64±2.29 in winter. Regression analysis indicated that strip meniscometry levels were correlated with BUT (p<0.001), Schirmer test values (p<0.001), corneal staining scores (p=0.022), and presence of dryness (p<0.001). Conclusion Strip meniscometry values exhibited distinct seasonality, being lowest in winter when the ambient condition is dry and cool, and were correlated with BUT, Schirmer test values, corneal staining scores, and the presence of subjective dryness.
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Affiliation(s)
- Masahiko Ayaki
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
- Otake Eye Clinic, Kanagawa, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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33
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Vermeulen C, van der Burg LLJ, van Geloven N, Eggink CA, Cheng YYY, Nuijts RMMA, Wisse RPL, van Luijk CM, Nieuwendaal C, Remeijer L, van der Meer PF, de Korte D, Klei TRL. Allogeneic Serum Eye Drops: A Randomized Clinical Trial to Evaluate the Clinical Effectiveness of Two Drop Sizes. Ophthalmol Ther 2023; 12:3347-3359. [PMID: 37843772 PMCID: PMC10640534 DOI: 10.1007/s40123-023-00827-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Allogeneic serum from blood donors is starting to be used to treat patients with dry eye disease (DED). However, the optimal dose is not known. We therefore aimed to evaluate the clinical efficaciousness and user-friendliness of micro-sized versus conventional-sized allogeneic serum eye drops (SEDs). METHODS In a randomized trial, patients with DED first receive micro-sized SEDs (7 µl/unit) for 1 month, followed by a 1-month washout, before receiving conventional-sized SEDs (50 µl/unit) for 1 month; or vice versa. The primary endpoint was the Ocular Surface Disease Index (OSDI) score. Secondary endpoints were tear break-up time (TBT), tear production (TP), and presence of corneal punctate lesions (CP). The user-friendliness of both application systems was also compared. A linear mixed model for cross-over design was applied to compare both treatments. RESULTS Forty-nine patients completed the trial. The mean OSDI score significantly improved from 52 ± 3 to 41 ± 3 for micro-sized SEDs, and from 54 ± 3 to 45 ± 3 for conventional-sized SEDs. Non-inferiority (margin = 6) of micro-sized SEDs was established. We demonstrate a significant improvement for TBT in case of conventional-sized SEDs and for CP in both treatment groups. TP trended towards an improvement in both treatment groups. The user-friendliness of the conventional drop system was significantly higher. CONCLUSIONS For the first time, non-inferiority of micro-sized allogeneic SEDs was established. The beneficial effect of both SED volumes was similar as measured by the OSDI score. Although user-friendliness of the micro drop system was significantly lower, it is an attractive alternative as it saves valuable donor serum. TRIAL REGISTRATION ClinicalTrials.gov (NCT03539159).
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Affiliation(s)
- Christie Vermeulen
- Department of Product and Process Development, Sanquin Blood Bank, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands
| | - Lars L J van der Burg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Catharina A Eggink
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yanny Y Y Cheng
- Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Robert P L Wisse
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chantal M van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carla Nieuwendaal
- Department of Ophthalmology, University Medical Center Amsterdam, Location AMC, Amsterdam, The Netherlands
| | - Lies Remeijer
- The Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Pieter F van der Meer
- Department of Product and Process Development, Sanquin Blood Bank, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands
- Department Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Dirk de Korte
- Department of Product and Process Development, Sanquin Blood Bank, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands
| | - Thomas R L Klei
- Department of Product and Process Development, Sanquin Blood Bank, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands.
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Kılıççıoğlu A, Oncel D, Celebi ARC. Autoimmune Disease-Related Dry Eye Diseases and Their Placement Under the Revised Classification Systems: An Update. Cureus 2023; 15:e50276. [PMID: 38196419 PMCID: PMC10775916 DOI: 10.7759/cureus.50276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
Dry eye disease (DED) is a chronic and progressive disorder involving the ocular surface, characterized by disturbances in tear film composition, instability of the tear film, and inflammation of the ocular surface. There are two forms of DED: aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE). Autoimmune diseases are systemic disorders involving multiple organs, including the eyes, and have a significant impact on DED. There have been multiple studies demonstrating the relation between autoimmune diseases and DED. This article reviews the current knowledge regarding the epidemiological characteristics, pathogenesis, and treatments of autoimmune disease-related DED.
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Affiliation(s)
- Alara Kılıççıoğlu
- Neurology, Szeged University, Szeged, HUN
- Ophthalmology, Acibadem University, Istanbul, TUR
| | - Deniz Oncel
- Ophthalmology, Stritch School of Medicine, Loyola University Chicago, Chicago, USA
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Sakakura S, Inagaki E, Ochiai Y, Yamamoto M, Takai N, Nagata T, Higa K, Sato Y, Toshida H, Murat D, Hirayama M, Ogawa Y, Negishi K, Shimmura S. A Comprehensive Assessment of Tear-Film-Oriented Diagnosis (TFOD) in a Dacryoadenectomy Dry Eye Model. Int J Mol Sci 2023; 24:16510. [PMID: 38003700 PMCID: PMC10671533 DOI: 10.3390/ijms242216510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/06/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Tear film instability is a major cause of dry eye disease. In order to treat patients with short tear film breakup time (TBUT)-type dry eye, the development of tear film stabilizing agents is essential. However, the lack of an appropriate animal model of tear film instability has made drug development difficult. Although rabbit dry eye models have been reported in the past, there are only a few reports that focus on tear film instability. Herein, we assessed the tear film stability of a rabbit dry eye model induced by dacryoadenectomy. A clinical evaluation of the ocular surface, interferometry, and histological assessments of the cornea and conjunctiva were performed. Following the removal of the lacrimal glands, TBUT was shortened significantly, with dimple and random breakup patterns prominently observed. Furthermore, the blink rate in this model increased after dacryoadenectomy, suggesting that this model partially captured the phenotypes of human short TBUT-type dry eye and may be useful as an animal model for investigating potential drug candidates.
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Affiliation(s)
- Saki Sakakura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
| | - Emi Inagaki
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
- Department of Physiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Yuichiro Ochiai
- Kitayama Labes Co., Ltd., 3052-1 Arai, Ina City 396-0025, Japan
| | | | - Naofumi Takai
- Kitayama Labes Co., Ltd., 3052-1 Arai, Ina City 396-0025, Japan
| | - Taeko Nagata
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
| | - Kazunari Higa
- Cornea Center and Eye Bank, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa 272-8513, Japan;
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Hiroshi Toshida
- Department of Ophthalmology, Juntendo University Shizuoka Hospital, Nagaoka 1129, Izunokuni City 410-2295, Japan;
| | - Dogru Murat
- Department of Ophthalmology, Tsurumi University, 2-1-3 Tsurumi, Yokohama 230-0063, Japan
| | - Masatoshi Hirayama
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
| | - Shigeto Shimmura
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (M.H.); (K.N.)
- Department of Clinical Regenerative Medicine, Fujita Medical Innovation Center, Fujita Health University, Haneda Innovation City Zone A, 1-1-4 Hanedakuko, Ota-ku, Tokyo 144-0041, Japan
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Li CR. Role of lymphotoxin alpha as a new molecular biomarker in revolutionizing tear diagnostic testing for dry eye disease. Int J Ophthalmol 2023; 16:1883-1889. [PMID: 38028523 PMCID: PMC10626360 DOI: 10.18240/ijo.2023.11.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/24/2023] [Indexed: 12/01/2023] Open
Abstract
Dry eye disease (DED), primarily classified as multifactorial ocular surface disorder, afflicts tens of millions of individuals worldwide, adversely impacting their quality of life. Extensive research has been conducted on tear film analysis over the past decades, offering a range of tests to evaluate its volume, health, and integrity. Yet, early diagnosis and effective treatment for DED continue to pose significant challenges in clinical settings. Nevertheless, by recognizing key phenomena in DED such as ocular surface inflammation, hyperosmolarity, and tear film instability, this article provides a comprehensive overview of both traditional and recently developed methods for diagnosing and monitoring DED. The information serves as a valuable resource not only for clinical diagnosis but also for further research into DED.
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Affiliation(s)
- Chao-Ran Li
- Tianjin Medical University Eye Hospital, Tianjin 310011, China
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37
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Araújo JNDM, Fernandes APNDL, Dantas AC, Ferreira MA, Lopes MVDO, Vitor AF. Ocular dryness in intensive care: proposal for a new nursing diagnosis. Rev Bras Enferm 2023; 76Suppl 4:e20220698. [PMID: 37971054 PMCID: PMC10642012 DOI: 10.1590/0034-7167-2022-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/27/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE to analyze the concept associated with diagnostic proposition Ocular dryness in adult patients hospitalized in an Intensive Care Unit, identifying its attributes, antecedents and consequences. METHODS a methodological study carried out through concept analysis, operationalized by scoping review. RESULTS the analysis of 180 studies allowed the identification of two attributes, 32 antecedents and 12 consequences. The attributes were tear film deficiency and ocular signs and/or symptoms. The prevalent antecedents were incomplete eyelid closure (lagophthalmos) and blinking mechanism decrease. Major consequences included conjunctival hyperemia and decreased tear volume. CONCLUSIONS this study allowed constructing nursing diagnosis Ocular dryness, part of domain 11, class 2, with 12 defining characteristics, 12 related factors, seven populations at risk and 13 associated conditions. This problem-focused proposal may provide targeted care by promoting early detection and implementing interventions that reduce the risk of ocular damage.
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Affiliation(s)
| | | | - Ana Clara Dantas
- Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil
| | | | | | - Allyne Fortes Vitor
- Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil
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Kawahara A. Treatment of Dry Eye Disease (DED) in Asia: Strategies for Short Tear Film Breakup Time-Type DED. Pharmaceutics 2023; 15:2591. [PMID: 38004570 PMCID: PMC10674215 DOI: 10.3390/pharmaceutics15112591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder in which tear fluid homeostasis is lost, resulting in increased tear film osmolarity and ocular surface irritation. In Asia, the short tear film breakup time-type DED, which has become a global problem in recent years, is common. While the mainstay of DED treatment in the West is the suppression of inflammation, the first goal of treatment is the stabilization of the tear film in Asia. To date, artificial tears and steroid eye drops have been the main treatment for DED. However, artificial tears require frequent administration of eye drops and thus pose adherence problems, while steroids have problems with side-effects (cataracts, increased intraocular pressure). This review evaluates the new generation therapies in Asia based on what is known about them and demonstrates that they are more effective for DED than traditional therapies such as artificial tears and steroids. Based on considerations, it is proposed that the optimal treatment for the short tear film breakup time-type DED is the initial application of mucin-secretion-enhancing eye drops (long-acting diquafosol) and oral supplements; and if additional treatment is needed, cyclosporine eye drops and the adjunctive therapies presented in this review are added.
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Affiliation(s)
- Atsushi Kawahara
- Yoshida Eye Hospital, 2-31-8, Hondori, Hakodate 041-0851, Hokkaido, Japan
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Nagino K, Inomata T, Nakamura M, Sung J, Midorikawa-Inomata A, Iwagami M, Fujio K, Akasaki Y, Okumura Y, Huang T, Fujimoto K, Eguchi A, Miura M, Hurramhon S, Zhu J, Ohno M, Hirosawa K, Morooka Y, Dana R, Murakami A, Kobayashi H. Symptom-based stratification algorithm for heterogeneous symptoms of dry eye disease: a feasibility study. Eye (Lond) 2023; 37:3484-3491. [PMID: 37061620 PMCID: PMC10630441 DOI: 10.1038/s41433-023-02538-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND/OBJECTIVE To test the feasibility of a dry eye disease (DED) symptom stratification algorithm previously established for the general population among patients visiting ophthalmologists. SUBJECT/METHODS This retrospective cross-sectional study was conducted between December 2015 and October 2021 at a university hospital in Japan; participants who underwent a comprehensive DED examination and completed the Japanese version of the Ocular Surface Disease Index (J-OSDI) were included. Patients diagnosed with DED were stratified into seven clusters using a previously established symptom-based stratification algorithm for DED. Characteristics of the patients in stratified clusters were compared. RESULTS In total, 426 participants were included (median age [interquartile range]; 63 [48-72] years; 357 (83.8%) women). Among them, 291 (68.3%) participants were diagnosed with DED and successfully stratified into seven clusters. The J-OSDI total score was highest in cluster 1 (61.4 [52.2-75.0]), followed by cluster 5 (44.1 [38.8-47.9]). The tear film breakup time was the shortest in cluster 1 (1.5 [1.1-2.1]), followed by cluster 3 (1.6 [1.0-2.5]). The J-OSDI total scores from the stratified clusters in this study and those from the clusters identified in the previous study showed a significant correlation (r = 0.991, P < 0.001). CONCLUSIONS The patients with DED who visited ophthalmologists were successfully stratified by the previously established algorithm for the general population, uncovering patterns for their seemingly heterogeneous and variable clinical characteristics of DED. The results have important implications for promoting treatment interventions tailored to individual patients and implementing smartphone-based clinical data collection in the future.
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Affiliation(s)
- Ken Nagino
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Juntendo University Graduate School of Medicine, AI Incubation Farm, Tokyo, Japan.
| | - Masahiro Nakamura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Precision Health, Department of Engineering, Graduate School of Bioengineering, The University of Tokyo, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shokirova Hurramhon
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Zhu
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Ohno
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuki Morooka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Akira Murakami
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Kobayashi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Kusada N, Yokoi N, Sotozono C. Association between Corneal Higher-Order Aberrations Evaluated with a Videokeratographer and Corneal Surface Abnormalities in Dry Eye. Diagnostics (Basel) 2023; 13:3319. [PMID: 37958214 PMCID: PMC10647685 DOI: 10.3390/diagnostics13213319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Analysis of higher-order aberrations (HOAs) is one reported method for evaluating dry eye disease (DED)-related loss of visual function. Tear film (TF) instability and corneal epithelial damage (CED) are both reportedly responsible for HOAs in DED, although, to the best of our knowledge, there are no reported methods that allow concurrent evaluation of their effects. In this study, we used a videokeratographer (VK) to continuously measure HOAs in DED after eye opening and investigated factors of ocular surface abnormalities that determine HOAs. This study involved 96 DED cases that underwent DED symptom assessment with a questionnaire and examination of tear volume, TF abnormalities (i.e., TF lipid-layer interference grades and spreading grades, and non-invasive breakup time and fluorescein breakup time), and CED, and their correlation with HOAs evaluated via VK. The results show that HOAs at 1 or 2 s after eye opening can reflect TF instability and CED within the central 4-millimeter-diameter area of the optical zone in DED eyes concurrently. This finding may be useful for the rapid and non-invasive detection and evaluation of degraded visual function in DED cases with a variety of clinical features.
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Affiliation(s)
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan; (N.K.); (C.S.)
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Li S, Wang Y, Yu C, Li Q, Chang P, Wang D, Li Z, Zhao Y, Zhang H, Tang N, Guan W, Fu Y, Zhao YE. Unsupervised Learning Based on Meibography Enables Subtyping of Dry Eye Disease and Reveals Ocular Surface Features. Invest Ophthalmol Vis Sci 2023; 64:43. [PMID: 37883092 PMCID: PMC10615148 DOI: 10.1167/iovs.64.13.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose This study aimed to establish an image-based classification that can reveal the clinical characteristics of patients with dry eye using unsupervised learning methods. Methods In this study, we analyzed 82,236 meibography images from 20,559 subjects. Using the SimCLR neural network, the images were categorized. Data for each patient were averaged and subjected to mini-batch k-means clustering, and validated through consensus clustering. Statistical metrics determined optimal category numbers. Using a UNet model, images were segmented to identify meibomian gland (MG) areas. Clinical features were assessed, including tear breakup time (BUT), tear meniscus height (TMH), and gland atrophy. A thorough ocular surface evaluation was conducted on 280 cooperative patients. Results SimCLR neural network achieved clustering patients with dry eye into six image-based subtypes. Patients in different subtypes harbored significantly different noninvasive BUT, significantly correlated with TMH. Subtypes 1 and 5 had the most severe MG atrophy. Subtype 2 had the highest corneal fluorescent staining (CFS). Subtype 4 had the lowest TMH, whereas subtype 5 had the highest. Subtypes 3 and 6 had the largest MG areas, and the upper MG areas of a person's bilateral eyes were highly correlated. Image-based subtypes are related to meibum quality, CFS, and morphological characteristics of MG. Conclusions In this study, we developed an unsupervised neural network model to cluster patients with dry eye into image-based subtypes using meibography images. We annotated these subtypes with functional and morphological clinical characteristics.
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Affiliation(s)
- Siyan Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yiyi Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Chunyu Yu
- Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Hangzhou Normal University, Hangzhou, China
| | - Qiyuan Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Pingjun Chang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Dandan Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Zhangliang Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yinying Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Hongfang Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Ning Tang
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Weichen Guan
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yana Fu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
| | - Yun-e Zhao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Eye Hospital of Wenzhou Medical University at Hangzhou, Hangzhou, China
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Papas EB. Diagnosing dry-eye: Which tests are most accurate? Cont Lens Anterior Eye 2023; 46:102048. [PMID: 37544866 DOI: 10.1016/j.clae.2023.102048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To demonstrate how the likelihood of making a correct diagnosis of dry eye disease varies according to the clinical test methods used. METHODS The probability of a person having dry eye, given that they return a positive test, was calculated for a range of standard tests, using the Bayes-Price rule. Global specificity and sensitivity values for each test were estimated by employing the Beta distribution to combine all relevant data obtained from a literature review. RESULTS At an assumed prevalence of 11.6%, the single test with the highest probability of a correct diagnosis was corneal staining (probability = 0.28) and the lowest was the ocular surface disease index - OSDI (0.14). The best combination of symptoms with a single test of tear film homeostasis was the 5-item dry eye questionnaire (DEQ-5) + corneal staining (0.42) while OSDI + tear film break up time (TBUT) was the worst (0.23). The simultaneous observation of conjunctival and corneal staining was associated with a probability of 0.49. The probability of a correct diagnosis increased with the number of positive tests, up to a maximum of 0.90 when all of DEQ-5, conjunctival and corneal staining, osmolarity and TBUT were positive. CONCLUSION A significant risk of misdiagnosis is associated with using any single test for dry eye disease, or the minimum TFOS DEWS II criterion of symptoms plus any single test of tear film homeostasis. To minimize this risk, the maximum number of tests available should be performed and the results used to inform diagnosis. The simultaneous occurrence of conjunctival and corneal staining should be considered a key outcome and be specified in future guidelines.
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Affiliation(s)
- Eric B Papas
- School of Optometry & Vision Science, L3 Rupert Myers Building, UNSW, Kensington, NSW 2052, Australia.
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Li T, Tang J, Wu X, Zhang Y, Du Y, Fang Q, Li J, Du Z. Evaluating the Efficacy of Polyglycolic Acid-Loading Tetrandrine Nanoparticles in the Treatment of Dry Eye. Ophthalmic Res 2023; 66:1148-1158. [PMID: 37690450 PMCID: PMC10614459 DOI: 10.1159/000533345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/13/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Dry eye disease (DED) is a multifactor-induced disease accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. Traditional anti-inflammation agent corticosteroids applied in DED treatment could result in high intraocular pressure, especially in long-term treatment. Therefore, we explored a nano drug that aimed to block the formation pathway of DED which had anti-inflammatory, sustained release, and good biocompatibility characteristics in this study. METHODS We prepared a novel nanomedicine (Tet-ATS@PLGA) by the thin film dispersion-hydration ultrasonic method and detected its nanostructure, particle size, and zeta potential. Flow cytometry was used to detect the cell survival rate of each group after 24 h of drug treatment on inflammed Statens Seruminstitut Rabbit Corneal (SIRC) cells. Observed and recorded corneal epithelial staining, tear film rupture time, and Schirmer test to detect tear secretion on the ocular surface of rabbits. The corneal epithelial thickness, morphology, and number of bulbar conjunctival goblet cells were recorded by H&E staining. Finally, we detected the expression of VEGF, IL-1β, PGE2, and TNF-α by cellular immunofluorescence staining and enzyme-linked immunosorbent assay (ELISA). RESULTS The encapsulation efficiency and drug loading of Tet-ATS@PLGA were 79.85% and 32.47%, respectively. At eye surface temperature, Tet can easily release from Tet-ATS@PLGA while that it was difficult to release at storage temperature and room temperature. After 2 weeks medication, Tet-ATS@PLGA can effectively improve the tear film rupture time and tear secretion time in a DED model (p <0.05). Compared with the normal group (62.34 ± 4.86 mm), the thickness of corneal epithelium in ATS (29.47 ± 3.21 mm), Tet-ATS (46.23 ± 2.87 mm), and Tet-ATS@PLGA (55.76 ± 3.95 mm) gradually increased. Furthermore, the flow cytometry indicated that Tet-ATS@PLGA can effectively promote the apoptosis of inflammatory SIRC cells, and the cellular immunofluorescence and ELISA experiments showed that the expression intensity of inflammatory factors such as VEGF, IL-1β, PGE2, and TNF-α decreased in this process. Interestingly, Tet also had the effect of reducing intraocular pressure. CONCLUSION Tet-ATS@PLGA can effectively promote the apoptosis of inflammatory corneal epithelial cells, thus inhibiting the expression of inflammatory factors to block the formation of DED and improve the secretion of tear on the ocular surface.
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Affiliation(s)
- Tao Li
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Ophthalmology, The First People's Hospital of Ziyang, Sichuan, China
| | - Juan Tang
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Endocrinology, The First People's Hospital of Ziyang, Sichuan, China
| | - Xiao Wu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Ophthalmology, The First People's Hospital of Ziyang, Sichuan, China
| | - Yu Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yangrui Du
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qilin Fang
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Ophthalmology, The First People's Hospital of Ziyang, Sichuan, China
| | - Jiaman Li
- Anesthesia Operation Center, The First People's Hospital of Ziyang, Ziyang, China,
| | - Zhiyu Du
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Acet Y, Dağ Y. Changes caused by fluorescein in the tear film evaluated with hybrid break-up time test as a new method - Part Two: Its effect on breakup locations and other quantitative values. Photodiagnosis Photodyn Ther 2023; 43:103651. [PMID: 37301526 DOI: 10.1016/j.pdpdt.2023.103651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To examine the changes caused by fluorescein in the tear film by analyzing the qualitative parameters such as breakup location and also detailed quantitative parameters. METHODS After determining the break-up time (BUT) value and breakup locations by the Non-invasive break-up time (NI-BUT) method, we re-evaluated the changes in the tear film stained with fluorescein using the topographical method. We called the topographic evaluation of the tear film stained with fluorescein as the Hybrid-BUT test. The results for the parameters obtained for each participant by the NI-BUT and Hybrid-BUT tests were compared. RESULTS Our study was conducted with 82 participants aged between 18 and 58 years (mean age 34.1 ± 11.1). The mean first break-up time value (BUT1) was 4.1 ± 2.7 s on the NI-BUT test versus 5.1 ± 3.2 s on the Hybrid-BUT test (p = 0.029). The mean average of all break-up time values (BUTAvg) for each participant was 7.2 ± 3.2 s on the NI-BUT test versus 8.4 ± 3.1 s on the Hybrid-BUT test (p = 0.004). After dividing the corneal surface into quadrants of 90°, there was no significant difference in the comparison of the locations of the first breakup (QUAD(First breakup)), the second breakup (QUAD(2nd breakup)) and the third breakup (QUAD(3rd breakup)) between the two tests (p>0.05). CONCLUSIONS Fluorescein affects quantitative values rather than qualitative parameters in tear film. We observed that the change caused by fluorescein in tear film break-up time could be detected objectively and in a documented manner using Hybrid-BUT test.
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Affiliation(s)
- Yakup Acet
- Department of Ophthalmology, Mardin Training and Research Hospital. Mardin, Turkey.
| | - Yaşar Dağ
- Department of Ophthalmology, Başakşehir çam ve sakura city hospital. Istanbul, Turkey
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Chiang JCB, Tran V, Wolffsohn JS. The impact of dry eye disease on corneal nerve parameters: A systematic review and meta-analysis. Ophthalmic Physiol Opt 2023; 43:1079-1091. [PMID: 37357424 DOI: 10.1111/opo.13186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/19/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Dry eye disease (DED) is a growing global health problem with a significant impact on the quality of life of patients. While neurosensory abnormalities have been recognised as a contributor to DED pathophysiology, the potential role of in vivo corneal confocal microscopy in detecting nerve loss or damage remains unclear. This systematic review with meta-analysis (PROSPERO registered CRD42022381861) investigated whether DED has an impact on sub-basal corneal nerve parameters. METHODS PubMed, Embase and Web of Science Core Collection databases were searched from inception to 9 December 2022. Studies using laser scanning confocal microscopy to compare corneal nerve parameters of DED with healthy eyes were included. Study selection process and data extraction were performed by two independent members of the review team. RESULTS Twenty-two studies with 916 participants with DED and 491 healthy controls were included, with 21 of these studies included in subsequent meta-analyses. There was a decrease in total corneal nerve length (-3.85 mm/mm2 ; 95% CI -5.16, -2.55), corneal main nerve trunk density (-4.81 number/mm2 ; 95% CI -7.94, -1.68) and corneal nerve branch density (-15.52 number/mm2 ; 95% CI -27.20, -3.84) in DED eyes compared with healthy eyes, with subgroup analysis demonstrating that these differences were more evident in studies using NeuronJ software, a semi-automated procedure. While this review found evidence of loss of corneal nerve parameters in eyes with DED compared with healthy controls, particularly with the use of a semi-automated image analysis method, it is evident that there is substantial heterogeneity between studies in terms of corneal nerve imaging methodology. CONCLUSIONS Standardisation is required in terms of terminology and analysis, with more research needed to potentially improve the clinical applicability and practicality of corneal nerve imaging. Further investigation is also required to confirm the diagnostic accuracy of this imaging modality and its potential for monitoring DED treatment efficacy.
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Affiliation(s)
- Jeremy Chung Bo Chiang
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
- School of Optometry and Vision Science, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Vincent Tran
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
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Mateo-Orobia AJ, Del Prado Sanz E, Blasco-Martínez A, Pablo-Júlvez LE, Farrant S, Chiambaretta F. Efficacy of artificial tears containing trehalose and hyaluronic acid for dry eye disease in women aged 42-54 versus ≥ 55 years. Cont Lens Anterior Eye 2023; 46:101845. [PMID: 37117131 DOI: 10.1016/j.clae.2023.101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Dry eye disease (DED) is common in postmenopausal women. This study evaluated efficacy of a 3-month daily treatment with artificial tears containing trehalose and hyaluronic acid (HA) in women aged 42-54 years (mixed-hormonal status) versus ≥ 55 years (postmenopausal) and with moderate and severe DED. METHODS This was a post-hoc analysis of three clinical trials assessing the efficacy of artificial tears containing trehalose (3%) and HA (0.15%) in women with an Ocular Surface Disease Index (OSDI) ≥ 18. Patients instilled one drop of the artificial tears in each eye 3 to 6 times daily and were evaluated at baseline and after 84 ± 7 days for DED symptom severity (OSDI), hyperemia (McMonnies scale), tear break-up time (TBUT), corneal and conjunctival staining (Oxford and Van Bjisterveld scales), tear production (Schirmer I test), and ocular symptoms. RESULTS A total of 273 women were evaluated, 61 of age 42-54 years; 212 of ≥ 55 years. DED symptoms, as measured by the OSDI, decreased significantly with the treatment in both age groups (p < 0.0001). Conjunctival hyperemia decreased significantly and TBUT increased significantly in both groups, especially in women of age 42-54 (both p < 0.0001). The global (corneal and conjunctival) staining score decreased significantly in both groups, but also more in women of age 42-54 years. No differences were observed between age groups for any of the variables measured, except for visual acuity. DED symptoms were consistently reported more frequently by the mixed hormonal status women, but also the effect of the treatment was more pronounced in this group. CONCLUSIONS Artificial tears with trehalose and HA significantly improved the symptoms of DED in women aged 42-54 and ≥ 55 years. The decrease in symptoms was more pronounced in women of age 42-54 years, suggesting better mechanisms of recovery from inflammation and loss of ocular surface homeostasis.
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Affiliation(s)
- Antonio J Mateo-Orobia
- Department of Ophthalmology, Hospital Universitario Miguel Servet, Zaragoza, Spain; Grupo de Investigación e Innovación Miguel Servet Oftalmología, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain; Instituto Oftalmológico Quirón-salud (Biotech Vision), Zaragoza, Spain.
| | | | | | - Luis E Pablo-Júlvez
- Department of Ophthalmology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah Farrant
- Earlam and Christopher Optometrists and Contact Lens Specialists, Taunton, United Kingdom
| | - Frédéric Chiambaretta
- Department of Ophthalmology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
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47
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Kusada N, Yokoi N, Kato H, Furusawa Y, Sakai R, Sotozono C. Evaluation of Dry Eye With Videokeratographer Using a Newly Developed Indicator. Am J Ophthalmol 2023; 252:135-146. [PMID: 36972740 DOI: 10.1016/j.ajo.2023.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To analyze the effectiveness of a newly developed indicator that quantitatively assesses disturbance in Meyer-ring (MR) images obtained via videokeratographer and assess its usefulness for the clinical evaluation of dry eye (DE). DESIGN Cross-sectional study. METHODS This study involved 79 eyes of 79 DE patients (10 males and 69 females; mean age: 62.7 years). After MR images were obtained via videokeratographer, the degree of blur was quantified at multiple points on the ring, with the total value across the cornea being defined as the disturbance value (DV). Correlations between total DV (TDV; the sum of DV for 5 seconds after eye opening) and 12 DE symptoms, Dry Eye-Related Quality of Life Score (DEQS), tear meniscus radius (mm), tear film (TF) lipid-layer spread grade (SG; grades 1-5, 1 = best), TF noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal epithelial damage score (CEDS; maximum: 15 points), conjunctival epithelial damage score (CjEDS; maximum: 6 points), and Schirmer 1 test value (mm) were analyzed via univariate and multivariate analyses. RESULTS No significant correlations were found between TDV and each DE symptom or DEQS, yet significant correlations were found between TDV and SG, NIBUT, FBUT, CEDS, and CjEDS (r = 0.56, -0.45, -0.45, 0.72, and 0.62, respectively, all P < .01). TDV was found to be described as 2334 + (412.1 × CEDS) - (302.0 × FBUT) (R2 = 0.593, P < .0001). CONCLUSIONS Our newly developed indicator, DV, reflecting TF dynamics and stability and corneoconjunctival epithelial damage, may be useful for quantitatively assessing DE ocular-surface abnormalities.
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Affiliation(s)
- Natsuki Kusada
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Norihiko Yokoi
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Hiroaki Kato
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuki Furusawa
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rieko Sakai
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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48
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Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
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49
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Zhuang D, Misra SL, Mugisho OO, Rupenthal ID, Craig JP. NLRP3 Inflammasome as a Potential Therapeutic Target in Dry Eye Disease. Int J Mol Sci 2023; 24:10866. [PMID: 37446038 DOI: 10.3390/ijms241310866] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial ocular surface disorder arising from numerous interrelated underlying pathologies that trigger a self-perpetuating cycle of instability, hyperosmolarity, and ocular surface damage. Associated ocular discomfort and visual disturbance contribute negatively to quality of life. Ocular surface inflammation has been increasingly recognised as playing a key role in the pathophysiology of chronic DED. Current readily available anti-inflammatory agents successfully relieve symptoms, but often without addressing the underlying pathophysiological mechanism. The NOD-like receptor protein-3 (NLRP3) inflammasome pathway has recently been implicated as a key driver of ocular surface inflammation, as reported in pre-clinical and clinical studies of DED. This review discusses the intimate relationship between DED and inflammation, highlights the involvement of the inflammasome in the development of DED, describes existing anti-inflammatory therapies and their limitations, and evaluates the potential of the inflammasome in the context of the existing anti-inflammatory therapeutic landscape as a therapeutic target for effective treatment of the disease.
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Affiliation(s)
- Dian Zhuang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand
| | - Odunayo O Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand
| | - Ilva D Rupenthal
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1142, New Zealand
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50
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Ebrahimi F, Ayatollahi H, Aghaei H. A clinical decision support system for diagnosing and determining severity of dry eye disease. Eye (Lond) 2023; 37:1619-1624. [PMID: 35996022 PMCID: PMC10219942 DOI: 10.1038/s41433-022-02197-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 07/03/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Dry eye and its related symptoms are the most common causes of referrals to the ophthalmology centers. Since people with dry eye may suffer from different levels of the disease severity, this study aimed to develop a clinical decision support system for diagnosing and determining severity of dry eye disease. METHODS This research was carried out in two phases in 2020. In the first phase, a questionnaire was designed to identify the most important diagnostic parameters from the cornea specialists' perspectives (n = 37). In the second phase of the research, a clinical decision support system was designed and implemented by using MATLAB software. Finally, the system was evaluated using patient data which were collected in a teaching hospital (n = 50). RESULTS The diagnostic parameters for dry eye disease were filamentary keratitis, meibomian gland dysfunction, score of ocular surface disease index, Schirmer's test result, tear meniscus height, tear breakup time, and fluorescein staining score. The system output variables were the diagnosis and severity of dry eye disease at four levels for the right and left eyes, separately. The results of the evaluation study showed that the accuracy, sensitivity and specificity of the system were 96.9%, 97.5%, and 93.7%, respectively. CONCLUSION It seems that the system designed in this study can help ophthalmologists to diagnose dry eye disease more accurately and quickly. However, it is recommended to conduct more evaluation studies and include more patients in the future research.
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Affiliation(s)
- Farzad Ebrahimi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Aghaei
- Department of Ophthalmology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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